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Using Severity-adjusted Mortality to Compare Performance in a Veterans Mffairs Hospital and in Private-sector Hospitals

Houston Center for Quality of Care and Utilization Studies, Section of General Medicine, Department of Internal Medicine, Houston Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Tex, hgordon{at}bcm.tmc.edu

David C. Aron, MD

Division of Clinical and Molecular Endocrinology and Institute for Health Care Research, Case Western Reserve School of Medicine, and the Cleveland Veterans Affairs Medical Center, Cleveland, Ohio

Susan M. Fuehrer, MBA

Cleveland Veterans Affairs Medical Center, Cleveland, Ohio

Gary E. Rosenthal, MD

Division of General Internal Medicine, University of Iowa, and the Iowa City VA Medical Center, Iowa City, IA

The objective of this study was to compare hospital mortality in Veterans Affairs (VA) and private-sector patients. The study included 5016 patients admitted to 1 VA hospital. Admission severity of illness was measured using a commercial methodology that was developed in a nation-wide database of 850,000 patients from 111 private-sector hospitals. The method uses data abstracted from patients' medical records to predict the risk of death in individual patients, based on the normative database. Analyses compared actual and predicted mortality rates in VA patients. VA patients had higher (P < .05) severity of illness than private-sector patients. The observed mortality rate in VA patients was 4.0% and was similar (P = .09) to the predicted risk of death (4.4%; 95% confidence interval 4.0-4.9%). In subgroup analyses, actual and predicted mortality rates were similar in medical and surgical patients and in groups stratified according to severity of illness, except in the highest severity stratum, in which actual mortality was lower than predicted mortality (57% vs 73%; P < .001). We found that in-hospital mortality in 1 VA hospital and a nationwide sample of private-sector hospitals were similar, after adjusting for severity of illness. Although not directly generalizable to other VA hospitals, our findings nonetheless suggest that the quality of VA and private-sector care may be similar with respect to one important and widely used measure.

Key Words: Hospital mortality • outcome assessment • regression analysis • veterans hospitals

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